🚀 Senior Medical Director (Medicare)

Overview

Job Summary: Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the provision of medical staff services. Maintains a working knowledge of applicable national, state and local laws and regulatory requirements affecting the medical and allied health staff.

Responsibilities

• Assists in recruitment, hiring and training of staff as needed.
• Analyzes data and identifies medical cost savings and quality improvement opportunities.
• Accounts for regulatory and accreditation performance of assigned team and responds to inquiries, issues and complaints from government and accreditation regulators.
• Directs the team in providing physician leadership and expertise in the performance of prior authorization, inpatient concurrent review, discharge planning, case management and interdisciplinary care team activities.
• Ensures that authorization decisions are rendered by qualified medical personnel, without hindrance due to fiscal or administrative incentives
• Supervises and manages Medical Directors
• Develops medical policies and procedures
• Conducts peer review

Job Qualifications

REQUIRED EDUCATION:

• Doctorate Degree in Medicine
• Board Certified or eligible in a primary care specialty

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 10+ years relevant experience, including 5+ years of clinical practice and 3+ years HMO/Managed Care experience OR 5 years experience as a Molina Medical Director
• Demonstrated experience in Utilization/Quality Program management
• Previous leadership experience
• Peer review, medical policy/procedure development, and provider contracting experience
• Current clinical knowledge
• Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen
• Knowledge of applicable state, federal and third party regulations
• Peer review, medical policy/procedure development, and provider contracting experience.

Licenses and Certifications

• Current State Medical License without restrictions (free of sanctions from Medicaid or Medicare)

Preferred

• Master’s in Business Administration, Public Health, Healthcare Administration, etc.
• Board Certification (Pediatrics, Family Practice, Ob/Gyn or Internal Medicine).

Physical Demands

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $214,132 - $417,557 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.